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Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Paradoxical immune reconstitution inflammatory syndrome (IRIS) is a recognized complication, particularly in tuberculosis (TB) infections.
  • Central nervous system (CNS) involvement in paradoxical IRIS presents a life-threatening challenge, often resistant to conventional therapies.
  • This condition can affect immunocompetent individuals, including children.

Purpose of the Study:

  • To describe a case of paradoxical IRIS with CNS involvement in an HIV-negative adolescent.
  • To highlight the therapeutic challenges and present an alternative treatment strategy.

Main Methods:

  • Case report of an HIV-negative refugee teenager.
  • Clinical presentation of brain tuberculomas and pseudoabscesses.
  • Evaluation of treatment response to thalidomide.

Main Results:

  • The patient presented with central nervous system tuberculomas and pseudoabscesses.
  • Standard treatments for paradoxical IRIS were ineffective.
  • Thalidomide demonstrated significant efficacy in resolving the CNS lesions.

Conclusions:

  • Paradoxical IRIS with CNS involvement is a critical condition requiring novel therapeutic approaches.
  • Thalidomide represents a potential treatment option for refractory cases of CNS tuberculomas associated with paradoxical IRIS.
  • This case underscores the importance of considering diverse treatment strategies for complex neurological infections.